Sellick's Maneuver: Cricoid Pressure, Aspiration
Cricoid Pressure
Summer Magdaleno
SJVC-STT11
Abstract
Airway management is the most important clinical skill for anesthesia care providers, emergency physicians, and other care providers that help with ventilation and oxygenation to the lungs. Cricoid pressure was discovered in 1961, by Dr. Sellick, therefore cricoid pressure is also known as Sellick’s maneuver. The cricoid pressure is used to reduce the risk of aspiration prior to induction of anesthesia and continued until the endotracheal tube is placed, verified and inflated. In this paper, I will discuss the history, anatomy, technique, benefits and, contradictions.
Keywords: Sellick’s Maneuver, Cricoid Pressure, Aspiration
Cricoid Pressure
The application of cricoid pressure is preformed …show more content…
to reduce the risk of aspiration. This technique is used to prevent the stomach contents released into the esophagus from entering the laryngopharynx, reducing the risk of aspiration into the respiratory tract. (Frey, 2017)
History
In 1774, the use of cricoid pressure was used in near drowning victims by Dr.
Monro. In 1961, a British anesthesiologist Dr. Brian A. Sellick conducted a study with cadavers that were filled with water and placed in the Trendelenburg position to reduce the chance of aspiration should a patient vomit. He identified that pulmonary aspiration as a significant problem during induction of anesthesia during emergency and obstetrics procedures. He proposed that the risk of aspirating could be decreased if the esophagus could be occluded by pressing the cricoid cartilage against the cervical vertebrae during induction of anesthesia or positive pressure mask ventilation. Ever since Dr. Sellick’s publication and findings, the application of cricoid pressure to the tracheal intubation is called Selleck’s maneuver. (Blackwell …show more content…
Publishing,2004)
Anatomy
The cricoid cartilage is a ring that surrounds the trachea (windpipe). It is located near the center and middle of the neck. This cartilage is made up of strong connective tissue, that include the dorsal (backside) part of the larynx (voice box). The external pressure causes blockage of the esophagus between the cricoid ring and the body of the sixth cervical vertebrae. The cricoid cartilage primary roles are to provide connectivity for different ligaments, muscles, cartilage, which facilitate the opening and shutting of the air passage and the production of sound. (www.heathline.com, 2015)
Technique
Before induction of anesthesia the cricoid ring must be identified and gently palpated.
Cricoid pressure should begin before the patient is fully asleep. Firm pressure is applied with the thumb and index finger forming a “V” to the cricoid cartilage, located slightly below the thyroid cartilage. Cricoid pressure must be applied prior to the induction of anesthesia and continued until the endotracheal tube is placed, the correct position of the tube is verified, and then the cuff of the endotracheal tube is inflated. The person applying cricoid pressure does not release the pressure until directed to do so by the anesthesia care provider controlling the airway.
(Frey,2017)
Benefits/ Contradiction
The use of cricoid pressure is performed to reduce the risk of aspiration by the patient undergoing general anesthesia. It is used when a patient requires emergency surgery and may have recently eaten, the pressure prevents contents of the stomach from regurgitating and possible aspiration occurring. There are several contradictions to the use of cricoid pressure. Cricoid pressure should not be used if patient is actively vomiting, suspected cricotracheal injury, unstable cervical spine injuries. The use of cricoid pressure may make intubation even more difficult in patients with a history of difficult intubation. Only individuals that have been fully trained to apply this technique should assist with this maneuver. Failure to apply pressure correctly can result in cricoid cartilage fracture. (Frey, Price,
2006)
Conclusion
In general, cricoid pressure appears to be a safe maneuver when applied correctly and the with the right amount of force. Contradictions include active vomiting, suspected cricotreacheal injury, unstable cervical spine injuries. Unwanted effects of cricoid pressure with the use of excessive pressure, include airway obstruction, more difficult intubation, as well as difficult ventilation. The main risk is inadequate pressure will lead to aspiration. More research is needed to see how useful the maneuver is, as the evidence supporting the use of cricoid pressure is surprising poor quality. Many studies including Dr. Sellick’s are small, and only have been performed on human and animal cadavers. (The Department of Anesthesia and Perioperative care, 2013)
Summer Magdaleno
SJVC-STT11
Abstract
Airway management is the most important clinical skill for anesthesia care providers, emergency physicians, and other care providers that help with ventilation and oxygenation to the lungs. Cricoid pressure was discovered in 1961, by Dr. Sellick, therefore cricoid pressure is also known as Sellick’s maneuver. The cricoid pressure is used to reduce the risk of aspiration prior to induction of anesthesia and continued until the endotracheal tube is placed, verified and inflated. In this paper, I will discuss the history, anatomy, technique, benefits and, contradictions.
Keywords: Sellick’s Maneuver, Cricoid Pressure, Aspiration
Cricoid Pressure
The application of cricoid pressure is preformed …show more content…
to reduce the risk of aspiration. This technique is used to prevent the stomach contents released into the esophagus from entering the laryngopharynx, reducing the risk of aspiration into the respiratory tract. (Frey, 2017)
History
In 1774, the use of cricoid pressure was used in near drowning victims by Dr.
Monro. In 1961, a British anesthesiologist Dr. Brian A. Sellick conducted a study with cadavers that were filled with water and placed in the Trendelenburg position to reduce the chance of aspiration should a patient vomit. He identified that pulmonary aspiration as a significant problem during induction of anesthesia during emergency and obstetrics procedures. He proposed that the risk of aspirating could be decreased if the esophagus could be occluded by pressing the cricoid cartilage against the cervical vertebrae during induction of anesthesia or positive pressure mask ventilation. Ever since Dr. Sellick’s publication and findings, the application of cricoid pressure to the tracheal intubation is called Selleck’s maneuver. (Blackwell …show more content…
Publishing,2004)
Anatomy
The cricoid cartilage is a ring that surrounds the trachea (windpipe). It is located near the center and middle of the neck. This cartilage is made up of strong connective tissue, that include the dorsal (backside) part of the larynx (voice box). The external pressure causes blockage of the esophagus between the cricoid ring and the body of the sixth cervical vertebrae. The cricoid cartilage primary roles are to provide connectivity for different ligaments, muscles, cartilage, which facilitate the opening and shutting of the air passage and the production of sound. (www.heathline.com, 2015)
Technique
Before induction of anesthesia the cricoid ring must be identified and gently palpated.
Cricoid pressure should begin before the patient is fully asleep. Firm pressure is applied with the thumb and index finger forming a “V” to the cricoid cartilage, located slightly below the thyroid cartilage. Cricoid pressure must be applied prior to the induction of anesthesia and continued until the endotracheal tube is placed, the correct position of the tube is verified, and then the cuff of the endotracheal tube is inflated. The person applying cricoid pressure does not release the pressure until directed to do so by the anesthesia care provider controlling the airway.
(Frey,2017)
Benefits/ Contradiction
The use of cricoid pressure is performed to reduce the risk of aspiration by the patient undergoing general anesthesia. It is used when a patient requires emergency surgery and may have recently eaten, the pressure prevents contents of the stomach from regurgitating and possible aspiration occurring. There are several contradictions to the use of cricoid pressure. Cricoid pressure should not be used if patient is actively vomiting, suspected cricotracheal injury, unstable cervical spine injuries. The use of cricoid pressure may make intubation even more difficult in patients with a history of difficult intubation. Only individuals that have been fully trained to apply this technique should assist with this maneuver. Failure to apply pressure correctly can result in cricoid cartilage fracture. (Frey, Price,
2006)
Conclusion
In general, cricoid pressure appears to be a safe maneuver when applied correctly and the with the right amount of force. Contradictions include active vomiting, suspected cricotreacheal injury, unstable cervical spine injuries. Unwanted effects of cricoid pressure with the use of excessive pressure, include airway obstruction, more difficult intubation, as well as difficult ventilation. The main risk is inadequate pressure will lead to aspiration. More research is needed to see how useful the maneuver is, as the evidence supporting the use of cricoid pressure is surprising poor quality. Many studies including Dr. Sellick’s are small, and only have been performed on human and animal cadavers. (The Department of Anesthesia and Perioperative care, 2013)